{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:25:48Z","timestamp":1787012748244,"version":"build-2736575974"},"reference-count":27,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["INQUIRY"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction\/Objective<\/jats:title>\n                    <jats:p>Deaf sign language users face persistent barriers to equitable healthcare, yet evidence from non-Western and lower-income contexts remains limited. This study explored the lived experiences of Deaf undergraduate students in Thailand, examining how communication barriers, health literacy gaps, and system design intersect to shape their access to equitable care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a qualitative study using semi-structured, in-depth interviews with ten Deaf undergraduate students (aged 18\u201322 years). Participants were recruited through purposive sampling and interviews were conducted in Thai Sign Language (TSL), facilitated by two professional interpreters working in tandem. Data were analyzed using Braun and Clarke\u2019s inductive thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The analysis revealed four key themes: (1) communication barriers affecting all dimensions of healthcare experience, (2) inaccessible and hearing-centered health information, (3) the critical need for a Deaf-inclusive healthcare system, (4) the lifelong impact of growing up in hearing families on health literacy. These findings highlight how systemic communication gaps directly influence the quality of care and patient empowerment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Communication barriers and health literacy gaps are structural features of hearing-centered healthcare systems that require systemic rather than individual solutions. Deaf sign language must be reconceptualized as a central component of equitable public health communication, supported by institutional infrastructure and enforceable policy mandates. These findings contribute to the international effort to address structural determinants of health inequity among Deaf communities globally.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00469580261466592","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T22:35:43Z","timestamp":1786574143000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Communication Barriers and Health Literacy Gaps Undermine Equitable Healthcare for Deaf Sign Language Users: A Qualitative Study"],"prefix":"10.1177","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4933-0715","authenticated-orcid":false,"given":"Patiparn","family":"Srisirirat","sequence":"first","affiliation":[{"name":"Faculty of Medicine Ramathibodi Hospital, Mahidol University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supak","family":"Sanguansap","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Ramathibodi Hospital, Mahidol University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natwasa","family":"Samchusin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Ramathibodi Hospital, Mahidol University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penphak","family":"Kaewdee","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Ramathibodi Hospital, Mahidol University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wipawee","family":"Kiewkam","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Ramathibodi Hospital, Mahidol University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilaiporn","family":"Pudchimphet","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Ramathibodi Hospital, Mahidol University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saipin","family":"Hathirat","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Ramathibodi Hospital, Mahidol University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/acm.0000000000004181"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-023-16924-w"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.15446\/rsap.V25n6.109176"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/acem.15037"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1080\/10810730.2015.1066468"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13690-023-01216-x"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-017-2287-y"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7517-9-16"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/deafed\/enad061"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10900-018-0511-3"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s44263-025-00207-0"},{"issue":"11","key":"e_1_3_8_13_2","first-page":"1465","article-title":"Barriers and Facilitators of Health Literacy among D\/deaf Individuals: A Review Article","volume":"46","author":"Naseribooriabadi T","year":"2017","unstructured":"Naseribooriabadi T, Sadoughi F, Sheikhtaheri A. Barriers and Facilitators of Health Literacy among D\/deaf Individuals: A Review Article. Iran J Public Health. 2017;46(11):1465-1474.","journal-title":"Iran J Public Health"},{"key":"e_1_3_8_14_2","unstructured":"Department of Empowerment of Persons with Disabilities. Report on the Situation of Persons with Disabilities in Thailand as of April 30 2026. 2026. Accessed May 15 2026.https:\/\/dep.go.th\/images\/uploads\/files\/Dashboard-042569.pdf"},{"key":"e_1_3_8_15_2","first-page":"11","volume-title":"Concluding observations on the initial report of Thailand: Committee on the Rights of Persons with Disabilities","author":"Committee on the Rights of Persons with Disabilities","year":"2016","unstructured":"Committee on the Rights of Persons with Disabilities. Concluding observations on the initial report of Thailand: Committee on the Rights of Persons with Disabilities; 2016:11. 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